The influence of augmented renal clearance on vancomycin blood concentrations in patients with traumatic brain injury: Case report

Abstract

Traumatic brain injury is a severe condition frequently complicated with infections, hypermetabolism, and augmented renal clearance (ARC). The ARC is a phenomenon characterized by increased creatinine clearance above 130 mL/min/1.73m2. This phenomenon has been associated with decreased blood concentrations of selected antibiotics, like vancomycin, probably causing treatment failure. Despite ARC's possible fatal consequences in our local medical community, it is rarely assessed. Patient with traumatic brain injury accompanied with secondary infection and augmented renal clearance accompanied with subtherapeutic vancomycin concentrations in the time of treatment is presented. Since concentrations of antibiotics are not routinely measured in Serbian hospitals, clinical practice adjustment and widely accepted method of antibiotics blood concentration measurement which is particularly important in critically ill patients is suggested. The clinical pharmacologist is a significant team member for the treatment of critically ill patients due to his/her expert knowledge of pharmacokinetics and drug interactions, especially important in this category of patients, contributing to positive clinical outcomes.

Keywords

• traumatic brain injuries
• augmented renal clearance
• vancomycin
• pharmacokinetic